Long-Term Survival for Traumatic Spinal Cord Injury in British Columbia, Canada: A Retrospective Evaluation of 20 Years of Linked Health Care Data.

Abstract

Patients living with traumatic spinal cord injury (TSCI) have seen many improvements in care and treatment, but life expectancy still falls below the general population. Measuring long-term survival rates and characterizing causes of death are required to identify ways of improving well-being and reduce premature mortality. The study conducted a retrospective analysis of population-based administrative and clinical data from 2001 to 2021 to measure long-term survival of TSCI, mortality predictors, and cause of death. Population-based hospital records linked with administrative databases in British Columbia, Canada, were used to identify those with TSCIs. Demographic and clinical summary statistics were calculated. Mortality rates for 1-, 5-, 10-, 15-, and >15-year survival were calculated using Kaplan-Meier methods. Factors associated with mortality throughout the study period were identified with Cox models. During the study period, 3624 patients were identified with TSCI. The mean age was 51.1 years (SD 21.19) and 2718 (75.0%) were male. Mortality rates at 1, 5, 10, 15, and >15 years were 11.2%, 19.6%, 25.4%, 28.3%, and 29.1%, respectively. Factors associated with mortality included cervical spine injuries, more comorbidities, older age, lower household income, presence of traumatic brain injury, and greater severity of initial injury (p < 0.001). Cardiac disease (22.3%) was the most common cause of death in TSCI patients followed by respiratory diseases (10.2%) and neoplasms (8.5%). The long-term survival of TSCI patients is a significant concern, and preventative measures to avoid injury are critical. Among those suffering TSCI, particularly high death rates are observed in those with cervical injuries, multiple comorbidities, and advanced age. Interventions are needed to reduce premature death among TSCI patients compared with the population.